Purpose: The CDC updated its review of the Cleveland case series of infant pulmonary hemosiderosis.

Design: Update/Review.

Outcome: In a 1997 follow-up study, the CDC used a case-control design and found that pulmonary hemorrhage in a total of ten infants from Cleveland, Ohio was due to major water damage in the house environment. The moisture purportedly led to increased levels of household fungi, including the toxin-producing mold S. chartarum. After that report was published, the CDC commissioned a group of CDC scientists and a group of outside experts to independently review the Cleveland investigation. Both groups concluded that the available evidence did not substantiate the alleged associations between household water damage or household fungi and pulmonary hemosiderosis. The reviewers felt that the data gathered in the investigation was biased and found it was not statistically significant. Both groups concurred that the following problems existed: the cases were not properly characterized as hemosiderosis; there were no standard methods for defining water damage or for inspecting the homes; the original statistical analyses were flawed or exaggerated; sampling methods were erratic, unreliable and subjectively applied; and there were no differences in the presence of S. chartarum between case and control homes.

Significant Quotes: "On the basis of the findings and conclusions in the reports of the CDC internal working group and the individual opinions of the external consultants, CDC advises that conclusions regarding the possible association between cases of pulmonary hemorrhage/hemosiderosis in infants in Cleveland and household water damage or exposure to S. chartarum are not substantiated adequately by the scientific evidence produced in the CDC investigation." (p. 182).

Defendants' Perspective: Even the original publishers of the study conceded that the study is inconclusive due to shortcomings in collection, analysis, and reporting of data.

Plaintiffs' Perspective: Plaintiffs' experts may point to the "trends" observed in the original reports by Dearborn and colleagues as evidence that there is an association between mold exposure and childhood pulmonary hemorrhage. Plaintiffs' experts may argue that the CDC review groups were biased against finding an association between mold exposure in low income dwellings and health problems.

Peer Review: No.

Relevance to Ongoing Cases: The Cleveland cases are among the most frequently cited examples of illness associated with indoor mold. This CDC report is useful for cross-examining experts that rely
on the original Dearborn and Etzel articles.

How to Obtain the Article: http://www.cdc.gov/mmwr/